Healthcare Provider Details

I. General information

NPI: 1538072202
Provider Name (Legal Business Name): JOSHUA RAY KIBBY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 E SCRIPPS RD
LAKE ORION MI
48360-2249
US

IV. Provider business mailing address

495 E SCRIPPS RD
LAKE ORION MI
48360-2249
US

V. Phone/Fax

Practice location:
  • Phone: 248-693-5420
  • Fax:
Mailing address:
  • Phone: 248-693-5420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801121856
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: